BLS-ACLS Rhythm Recognition

DR. AFTAB AHMED MUSTAFA

 Knowing how to read and interpret ECGs is a critically important skill in BLS, ACLS and
PALS.
 The P wave corresponds to electrical impulse traveling through the atria. This is
synonymous with atrial depolarization and usually corresponds with atrial contraction.
 The QRS complex corresponds to the depolarization of the left and right ventricles. It
generally corresponds to the contraction of the ventricles.
 The T wave corresponds to a repolarization of the ventricles.
Sinus Rhythm

 A sinus rhythm is regular with normal P, Q-R-S, T deflections and intervals.  Rate = 60-
100 at rest.
Sinus Bradycardia

 Sinus bradycardia is a sinus rhythm with a rate less than 60 per minute in an adult.
Sinus Tachycardia

 Sinus tachycardia is a sinus rhythm with a rate greater than 100 per minute in an adult.
Note that the p waves are still present.
Supraventricular Tachycardia

 Supraventricular tachycardia (SVT) is an extremely fast atrial rhythm with narrow QRS
complexes when the impulse originates above the bundle branches (above the ventricles).
Atrial Fibrillation

 Atrial Fibrillation (Afib or AF) is a very common arrhythmia.  This rhythm is characterized
by no waves before the QRS complex and a very irregular heart rate.
Atrial Flutter

 Atrial flutter is a supraventricular arrhythmia that is characterized by a “saw-toothed”

flutter appearance on the ECG that represents multiple P waves for each QRS complex.
Asystole

 Asystole is also commonly known as a “flat line” where there is no electrical activity seen
on the cardiac monitor.  Not responsive to electrical defibrillation.
Pulseless Electrical Activity

 Can be virtually any organized ECG rhythm in a patient who is unresponsive and lacks a
palpable pulse. Thus, one cannot learn a PEA rhythm. It should not be confused, however,
with specific pulseless scenarios listed previously.
Ventricular Tachycardia

 Ventricular tachycardia (Vtach or VT) is characterized by bizarre widened QRS

complexes, no P waves and usually a rate over 100 per minute.  May quickly degenerate to
Ventricular fibrillation and death.  VT may be responsive to electrical defibrillation.
Monomorphic Ventricular Tachycardia

 With monomorphic VT all of the QRS waves will be symmetrical. Each ventricular
impulse is being generated from the same place in the ventricles thus all of the QRS waves
look the same.
Treatment of monomorphic VT is dependent upon whether the patient is stable or unstable.
Polymorphic Ventricular Tachycardia

 With polymorphic ventricular tachycardia, the QRS waves will not be symmetrical. This is
because each ventricular impulse can be generated from a different location. On the
rhythm strip, the QRS might be somewhat taller or wider.
One commonly seen type of polymorphic ventricular tachycardia is torsades de pointes.
Torsades and other polymorphic VT are advanced rhythms which require additional
expertise and expert consultation is advised.
Ventricular Fibrillation

 Ventricular fibrillation (Vfib or VF) is characterized by a chaotic wave pattern and no

pulse.  VF may be responsive to electrical defibrillation.
 Ventricular fibrillation or VF occurs when there are uncoordinated contractions within the
ventricles of the heart. The primary cause of VF is hypoxia (lack of oxygen) to the heart
muscle which causes hyperirritability in the cardiac muscle tissue.
 As a result, multiple muscles cells within the ventricles simultaneously fire as pacemakers
causing a quivering or fibrillation that is ineffective for adequate cardiac output.
THANK YOU AND GOOD LUCK
FOR CAT